Treatments for bipolar disorder

Bipolar disorder usually requires a long-term treatment plan often involving medication as well as psychological treatment and lifestyle approaches. There are a range of effective treatments for bipolar disorder, and it is possible to manage with the right treatment.

Treatments for bipolar disorder

Bipolar disorder usually requires a long-term treatment plan often involving medication as well as psychological treatment and lifestyle approaches. There are a range of effective treatments for bipolar disorder, and it is possible to manage with the right treatment.

Bipolar disorder is a chronic mental health condition, that means it is ongoing and needs careful management throughout your life. The changing moods associated with bipolar disorder can become very disruptive and debilitating, getting in the way of how we are living our everyday lives.

Start by talking to your GP so that you can find the treatment that works best for you.

There are two major parts to managing bipolar disorder; acute management and long-term management.

Acute management

Acute management aims to stabilise someone currently experiencing mania or depression. Medications like mood stabilisers and antipsychotics are the main focus of acute management of bipolar mania and depression. Electroconvulsive therapy (ECT) can be effective for treatment-resistant acute mood episodes, especially in people experiencing depression with psychotic features.

Long-term management

Long-term management involves maintenance and prevention of relapse, and optimised functional recovery socially and at work. Medications and psychological and lifestyle approaches are aimed at providing long-term prevention of relapse, building resilience, and improving quality of life.

Other medical conditions can occur at the same time as bipolar disorder

Treatment for bipolar disorder needs to factor in any co-conditions (sometimes called comorbidities) like anxiety or substance use disorder. Other medical illnesses such as hypertension, obesity and thyroid problems sometimes occur together with bipolar disorder. Treatment needs to be ongoing and tailored for each individual.

People who experience ‘rapid cycling’ can go between depression and mania a few times a week (some even cycle within the same day).

Others might have mood changes less often and less severely.

Some people can have very severe episodes of mania with psychotic symptoms (hallucinating or delusions) and need hospitalisation.

Some people have ‘mixed symptoms’ (symptoms of depression and mania within the same episode).

Some people can experience normal moods in between their swings, though the majority of individuals experience some low level symptoms between episodes.

Mental health practitioners need to work out your treatment according to whether you’re experiencing hypomania, mania, depression or euthymia (absence of depression or mania). A highly qualified mental health practitioner needs to prescribe your treatment. Each person needs a treatment plan tailored for their individual needs. Do not try to self-medicate or develop your own treatment plan.

Hospital and bipolar disorder

Hospital treatment might be needed if someone with bipolar disorder has become:

psychotic

highly excited

aggressive

suicidal

involved in clearly destructive behaviour.

While some people may be manageable outside the hospital setting (perhaps with the assistance of community mental health resources), admission can be necessary. There are three broad categories of treatment for bipolar disorder:

physical (medications and ECT)

psychological (counselling, psychotherapy, psychoeducation)

self-help, lifestyle changes and complementary therapies.

While use of medication is of primary importance, ideally a long-term treatment and preventative plan should combine physical, psychological and lifestyle approaches to manage bipolar disorder.

Medication

Your doctor should undertake a thorough consultation before deciding which medication is a good option for you. A specialist in treating bipolar disorder, such as a psychiatrist, is often involved in prescribing treatment.

Taking medication for bipolar disorder must be supervised by a doctor. Your doctor should explain the reasons for choosing the medication they’ve prescribed.

Studies show that medications are the most effective in long-term treatment of bipolar disorder and decrease the risk of relapse.

Medication can also improve people’s adherence to prescribed treatment and reduce the number of hospital admissions.

Your doctor will also discuss the risks and benefits, side effects, and how regularly you need check-ups.

Your doctor can also advise what treatments can work together with the medication, such as psychotherapy, lifestyle changes (e.g. exercise), and other support options.

The three main types of medications that are used in the treatment of bipolar include mood stabilisers, antidepressants and antipsychotics. The type and combinations of medications is very specific and depends on your symptoms.

Mood stabilisers

Mood stabilisers that treat or prevent mania or hypomania. Some common examples include lithium carbonate and sodium valproate.

Antidepressants

Antidepressants treat depression. There are many different antidepressants. Examples include selective serotonin reuptake inhibitors (SSRIs) and dual action antidepressants. The use of antidepressants in bipolar depression is now considered safe for most people but should be closely supervised by a psychiatrist as for some people antidepressants may trigger manic episodes or rapid cycling.

Antipsychotics

Antipsychotics may be used if there are psychotic symptoms (i.e. hallucinations or delusions).

Some types of bipolar may need different medications and combinations such as:

rapid cycling bipolar (four or more episodes of highs and lows in 12 months)

How can psychological therapies help with bipolar disorder?

Recent studies recommend psychological therapies (or 'talking therapies') such as psychotherapy, cognitive behavioural therapy (CBT), or counselling as an additional treatment for bipolar disorder, alongside medication. There is evidence that these 'adjunctive therapies' can help reduce risk of relapse and improve quality of life through:

assisting acceptance of bipolar disorder

identifying early warning signs and intervening

minimising recurrences and hospitalisation

maintaining adherence to medication plans

decreasing depressive symptoms

improving knowledge and skills to manage bipolar disorder

helping cope with stressful events and family conflicts

assisting in maintaining regular sleep patterns and daily routines

improving family relationships, communication and reengaging at work

reducing drug and alcohol use.

These programs should be delivered by mental health professionals with training and experience in managing bipolar disorder.

Cognitive behavioural therapy (CBT)

Family focused therapy

This therapy generally involves patients and their caregivers having about 21 sessions involving psychoeducation and problem-solving training, together with enhancing communication skills.

Through family psychoeducation you learn about:

causes of bipolar disorder

how to identify triggers

the warning signs of relapse

medications and possible side-effects

psychological treatments

healthy lifestyle changes.

This information helps improve the way individuals and their families successfully manage the condition.

Educating caregivers about bipolar disorder can be beneficial even when patients don’t attend sessions.

Interpersonal and social rhythm therapy

This is based around evidence that mood instability in bipolar disorder may be related to changes in circadian rhythms. Interpersonal and social rhythm therapy is an adaptation of interpersonal psychotherapy for depression. It applies a problem solving approach and helps patients maintain routines in sleep and wake rhythms.

Group psychoeducation

Using a pre-designed program, group psychoeducation explores awareness, adherence to treatment, early detection of symptoms and sleep routines.

Web-based mood and sleep tracking tools

There are a number of web-based tracking tools that can be used in conjunction with medications and psychotherapy to track mood and sleep cycles and provide real-time information to health care providers.

Staying on track with medications and treatments for bipolar disorder

A team approach works best

There are things we can do to help our progress, and to stay on track. Taking a team approach with your GP, psychologist, psychiatrist and family is the best way you can manage bipolar disorder.

The team can create a wellbeing plan that helps you stick to prescribed treatments. It helps you and your family know your warning signs, and can minimise impacts of the illness on your everyday life.

Other things can assist in helping you manage the disorder and maintain quality of life, including:

acceptance of the diagnosis of bipolar disorder

psychoeducation including education of our families or carers

motivation to stick to a management plan (including medication)

awareness and self-monitoring of mood

relapse prevention and management
and knowing our relapse triggers

integrating diagnosis into a sense of self.

Wellbeing plans

Having a 'wellbeing plan' is an important psychological tool for maintaining wellness between highs and lows and for preventing the exacerbation of low-level symptoms into full-blown episodes. You and your doctor can develop a personalised wellbeing plan to help keep you on track. Wellbeing plans for bipolar disorder:

Bipolar disorder can occur during pregnancy or after the birth of a baby. It may be a first episode or a relapse. Women with a family history of bipolar disorder are at an increased risk of an episode occurring during pregnancy and after childbirth, so it's important to be aware of any early symptoms.

There are important safety considerations around use of medication and its effects on the unborn baby.

Some medications are not safe to use in the first trimester and while breastfeeding. It's very important to seek guidance if you're planning to have a baby and you have bipolar disorder or a family history of bipolar disorder.

Treatment of bipolar disorder during pregnancy and after birth may require special care by a psychiatrist.

The sooner a management plan is put in place the less frequent and intense the episodes can be. With the right treatment bipolar disorder can be effectively controlled.

How to help a young person with bipolar disorder

Adolescence can be a tumultuous time. Young people with bipolar disorder may not understand what’s happening to them, or may think that the highs and lows of bipolar disorder are simply part of growing up. Try the following to support a young person that is trying to, or needs to, seek help.

Talk to them and let them know that you are concerned

Help them identify possible contributing factors for why they may feel unwell i.e. stress, exams, drugs, home life

Recommend they see a GP

After seeing a GP, they may be referred to a psychiatrist or psychologist; let the them know that they can bring a friend or family member along for support

If they are prescribed a treatment plan or medication, assist them in closely following the instructions.